Ideally this decision should be a joint decision between you and your medical team. We do however recognise that not everyone has access to an experienced team and some of you may need to begin weaning whilst you are waiting to be referred. This advice is not meant to be a substitute for proper medical advice and is merely a place to start.
Current guidelines on weaning of babies with FPIES suggest that introduction of high risk foods such as cows milk, soya, grains, poultry, and legumes should be probably be delayed and 'introduction of yellow fruits and vegetables are recommended prior to introduction of grains'
Foods from the same food family as those failed previously should be avoided initially for example if oats caused a reaction, the introduction of other grains should be delayed. Some studies have also shown that infants that react to cow's milk may also react to soya.
If your child is already tolerating one food from a higher risk food group (for example, soy for legumes, chicken for poultry, or oat for grains) it is a sign that your baby may tolerate other foods from that same food group.
Many parents take the following criteria into account when choosing a food to trial:
There is no standard protocol for food trials and will depend upon your child's previous level of sensitivity and time taken to react. One common protocol is outlined below:
The food to be trialed should be tried with a teaspoon on day 1, 2 teaspoons on day 2, then either continue to double daily or give a ‘usual portion’ for the remaining days with 7 days in total. The food can be considered ‘safe’ if no reactions.
For foods whose protein structure is altered by baking e.g. egg and milk a ladder approach is best. Please contact your dietitian for more information prior to trialing.
The length of trial needed will be determined by how many times your baby ate a previous food before a reaction was seen e.g. If your baby reacted to chicken the 2nd time they ate it, food trials would need to be a minimum of 3 days long and to be safe maybe 5 or 6 days. If at the end of your trial period you are unsure if the food is causing symptoms, the trial can be either extended or paused to be re-trialed at a later date.
Some people also choose to include a break in a trial of 2 or 3 days into each trial as symptoms are sometimes more pronounced after a break. So the food would be given for 5 days, then there would be a 2 day break where the trial food was not given. The food would then be given for a further 2 days before being deemed 'safe'. Please discuss this with your doctors and dietitians if possible.
It is very important that the food to be trialed should contain only one ingredient. This is true of alternative milks containing fruit juices and thickeners, the main ingredient should ideally be trialed on its own first. It is probably best at first to buy the food fresh (and possibly organic) and prepare it by washing, peeling, boiling in water and pureeing (if applicable).
During food trials any foods that are already well tolerated can be given alongside the food to be trialed. Most parents choose to give the new food in the morning so that any reaction will be during daytime hours. It is best to ignore the idea of breakfast, lunch and dinner altogether. If the trial is beef then your baby will have beef for breakfast, not traditional but it's no big deal either.
At first this all seems very daunting and it is very difficult to be patient with food trials that seem to move at a snails pace. As time goes on you may be able to shorten trials to 2 or 3 days as it becomes clear which groups of foods are problematic. Indeed many children have only one or two problem foods such as milk and soya and quickly learn that all other foods are fine.
Some children only have one or two FPIES trigger foods. In rare cases some may have as many as 6 or 7 foods which cause acute reactions. Also It is also possible for children with FPIES to also have milder non-IgE mediated allergies to multiple foods.
If you require more practical advice on food trials and where to find particular products, please join our Facebook group where there are a host of families online willing to offer practical guidance.
DISCLAIMER: FPIES UK is a support, education and awareness resource. Information placed here is not intended to be taken as medical advice. This website is not intended to be a substitute for medical care. Always consult a doctor or dietitian for individual advice, diagnosis and treatment.